第十二章玻璃体病课件

第十二章 玻璃体病 上海交通大学附属第一人民医院上海交通大学附属第一人民医院 眼科眼科 孙晓东孙晓东 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 目的和要求 n了解玻璃体的形态、结构特征，生 理功能 n了解用检眼镜检查玻璃体混浊 n了解玻璃体混浊的各种原因 n了解玻璃体混浊的治疗 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 玻璃体玻璃体 形态特征形态特征 vitreous vitreous 玻璃体 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 玻璃体生理玻璃体生理 n 透明的凝胶状态，98%水、透明质酸、网状的II 型胶原和少量玻璃体细胞 n 内界膜IV型胶原通过粘多糖与后界膜粘连 n 粘连最紧密处：视盘、黄斑、大血管、基底部、 视网膜变性处 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 概 述 功功 能能 n n 胚胎期眼发育重要作用胚胎期眼发育重要作用 n n 保持高度透明减少光散射保持高度透明减少光散射 n n 对周围组织的支持减震作用对周围组织的支持减震作用 n n 代谢作用，主动转运代谢作用，主动转运 n n 屏障作用屏障作用 n n 抑制新生血管形成抑制新生血管形成 基本病理过程基本病理过程 n n 液化，混浊，与视网膜关系密切液化，混浊，与视网膜关系密切 n n 治疗原则：保守、病因治疗、手术治疗原则：保守、病因治疗、手术 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 玻璃体病的检查手段 n直接眼底镜 n三面镜检查 n间接检眼镜、78/90D前 置镜 n眼底照像 n B超诊断 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 玻璃体液化、后脱离、变性 玻璃体液化玻璃体液化 n n 代谢、代谢、HAHA构型、年龄、胶原退化、光毒性、激素水构型、年龄、胶原退化、光毒性、激素水 平等有关平等有关 n n 引起透明质酸降解，纤维支架塌陷，凝胶变性液引起透明质酸降解，纤维支架塌陷，凝胶变性液 体体 n n 4040岁以后，中央开始，逐渐扩大岁以后，中央开始，逐渐扩大 n n 与年龄、近视、外伤、出血、炎症、无晶体眼有关与年龄、近视、外伤、出血、炎症、无晶体眼有关 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 玻璃体后脱离(PVD) n n 发生率发生率：50506060岁为岁为5353，6565岁为岁为65%65%，另有报道，另有报道7070 8080岁为岁为25255151，8080岁为岁为63%63%，无晶体眼高，无晶体眼高7 71010倍倍 n n 临床分类：临床分类：完全、部分、无完全、部分、无PVDPVDEvaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 玻璃体后脱离玻璃体后脱离(PVD)(PVD) n n 症状症状：闪光感、黑影飘：闪光感、黑影飘 n n 体征体征：WeissWeiss环形成，视网膜上散在小点片出血，环形成，视网膜上散在小点片出血， 131319%19%有玻璃体微小出血有玻璃体微小出血 n n 并发症并发症：玻璃体出血、急性：玻璃体出血、急性PVDPVD裂孔发生率裂孔发生率7 715%15% ，玻璃体出血裂孔发生率，玻璃体出血裂孔发生率65%65%，且大部导致，且大部导致RDRD n n 注意点：急性注意点：急性PVDPVD，眼底仔细检查，眼底仔细检查 飞蚊症：飞蚊症：7070由液化和由液化和PVDPVD引起，随访检查引起，随访检查 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. WeissWeiss环形成环形成 裂孔形成和裂孔形成和 玻璃体出血玻璃体出血 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 急性PVD 无并发症的PVD (85%) 视网膜裂孔形成/出血 (10-15%) 视网膜血管撕脱/出血 (罕见) Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 马蹄形裂孔视网膜脱离 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 视网膜裂孔的处理视网膜裂孔的处理 n干性裂孔 视网膜光凝 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 玻璃体视网膜界面异常玻璃体视网膜界面异常 n n 玻璃体黄斑牵拉综合征、特发性黄斑前膜、特发性玻璃体黄斑牵拉综合征、特发性黄斑前膜、特发性 黄斑裂孔黄斑裂孔 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 玻璃体变性玻璃体变性 n n 星状玻璃体变性、闪辉性玻璃体液化、淀粉样变性星状玻璃体变性、闪辉性玻璃体液化、淀粉样变性 玻璃体积血玻璃体积血 病病 因因 n n 源于视网膜和脉络膜破损的血管或新生血管源于视网膜和脉络膜破损的血管或新生血管 n n 视网膜血管病变、眼外伤或手术、其他眼底病视网膜血管病变、眼外伤或手术、其他眼底病 症状：症状：少量飞蚊症，大量视力急剧减退，原发病表现少量飞蚊症，大量视力急剧减退，原发病表现 预后：预后：介质混浊，液化介质混浊，液化PVDPVD发生逐渐吸收，严重致发生逐渐吸收，严重致 PVRPVR、RDRD、或血影细胞性青光眼发生、或血影细胞性青光眼发生 检查：检查：全身检查，超声波，电生理检查全身检查，超声波，电生理检查 治疗：治疗：药物及物理疗法，手术治疗药物及物理疗法，手术治疗 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 其他玻璃体病 n n 玻璃体炎症玻璃体炎症 n n 寄生虫病猪囊尾蚴、弓形虫寄生虫病猪囊尾蚴、弓形虫 n n 家族性渗出性玻璃体视网膜病变：显性遗传家族性渗出性玻璃体视网膜病变：显性遗传 n n 玻璃体发育异常玻璃体发育异常: : 晶状体血管膜，永存原始玻晶状体血管膜，永存原始玻 璃体增生症（璃体增生症（PHPVPHPV），视盘前血管袢），视盘前血管袢 n n 增生性玻璃体视网膜病变增生性玻璃体视网膜病变 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. PVR-B Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. PVR-C1 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. PVR-C2 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. PVR-C3 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. PVR-D1 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. PVR-D2 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. PVR-D3 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 视网膜下条索样改变 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 玻璃体手术 n n 1970 Machemer1970 Machemer发明世界第一台玻璃体注吸切割发明世界第一台玻璃体注吸切割 器器VISC(Vitreous Infusion Suction Cutter) VISC(Vitreous Infusion Suction Cutter) n n 8080年代以后玻璃体显微器械的改进、发明，手年代以后玻璃体显微器械的改进、发明，手 术成功率大大提高术成功率大大提高飞跃飞跃 适适 应应 证证 n n 视网膜血管并发症视网膜血管并发症 n n 复杂性视网膜脱离和眼外伤复杂性视网膜脱离和眼外伤 n n 黄斑病黄斑病 n n 慢性葡萄膜炎、玻璃体炎